October 2007 WSP Mission To help the poor gain sustained access to water and sanitation services. WSP Funding Partners The Governments of Australia, Austria, Belgium, Canada, Denmark, France, Ireland, Luxembourg, the Netherlands, Norway, Sweden, Switzerland, the United Kingdom, the United States of America, the United Nations Development Programme, The World Bank and the Bill and Melinda Gates Foundation. AusAID provides WSP-SA programmatic support.
Acknowledgments Research and fieldwork for this Manual is funded by the Bill and Melinda Gates Foundation through the WSP. This Training Manual is based on a training curriculum developed by Mr. Kamal Kar, initiator of community-driven total sanitation in rural areas. This curriculum has been through extensive field testing and our sincere thanks to all members of village communities, who contributed generously with their time and efforts to participate in discussions and PRA exercises. In addition, both the curriculum and guidance notes have been refined based on a series of policy discussions, workshops and interactions with national, state and local governments and expert practitioners in South Asia. The Training Manual was developed and written through collaboration with WSPs partner resource agencies, Knowledge Links and Feedback Ventures. The publication of this Manual was supported by Ms. Vandana Mehra, Regional Communications Specialist, WSP-SA. Management Team Soma Ghosh Moulik and C. Ajith Kumar Coordination Team K. Arokiam and Upneet Singh
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A set of nine Guidance Notes covering topics such as facilitating participatory training, principles and practices of community-driven total sanitation, sanitation technologies, hygiene practices, and monitoring.
Trainers Notes
Provides curriculums and guidance to trainers on how to facilitate a five-day Training of Trainers Program on community-driven total sanitation.
Curriculums and session plans. Training resources, e.g., handouts, presentations. Trainers tips.
List of Abbreviations
BPL CRSP DALY GoI GP HP IEC NGO NGP ODF PHAST PM&E PRI PS SHG TSC VIP WSP ZP below poverty line Central Rural Sanitation Program disability adjusted life years Government of India Gram Panchayat Himachal Pradesh information, education, communication nongovernmental organization Nirmal Gram Puraskar open defecation free Participatory Hygiene and Sanitation Transformation Manual participatory monitoring and evaluation Panchayati Raj Institution Panchayat Samiti self-help group Total Sanitation Campaign ventilated improved pit Water and Sanitation Program Zilla Parishad
Contents
Guidance Note 1
Introduction to Participatory Training 6
Guidance Note 2
The Sanitation Challenge 10
Guidance Note 3
Approaches to Rural Sanitation 12
Guidance Note 4
Community-driven Total Sanitation: Key Principles 16
Guidance Note 5
Triggering Behavior Change 20
Guidance Note 6
Community-driven Total Sanitation: Toolbox 22
Guidance Note 7
Sanitation Technologies 31
Guidance Note 8
Sanitation Hygiene Practices 39
Guidance Note 9
Participatory Monitoring 43
GUIDANCE NOTE 1
Key Messages
Participatory training builds on the knowledge and experiences of participants, which is more conducive to adult learning than conventional training methodologies. Effective facilitators help participants to discover their own capacities, instead of directing or dominating the learning process. In a participatory training, new information appears continuously. Therefore, the training design must remain flexible to accommodate the expressed learning needs of the participants.
Conventional Training Follow instructions. Passive participation. Receive information. Little responsibility for learning process.
Participatory Training
Offer ideas based on experience. Active participation (ask questions, make mistakes as part of the training process). Share ideas and experiences. Take ownership of learning process. Is a facilitator. Respects participants knowledge and experiences.
Trainers Role
Training Content
Method Focus
Do you know why participants are attending? Has the selection of participants followed the checklist outlined in Attachment 1 of the Trainers Notes?
Adults learn best when the context of the training is relevant to their own lives and experiences.
Have participants been asked to share their expectations and what they hope to achieve by the end of the training program? Do you have a system for guiding participants whose expectations are not well matched to yours or the groups?
Adults have experience and can help each other learn through an atmosphere of sharing.
What prior knowledge may trainees have about the subject matter of training? Will your training methods build upon and use the ideas and skills of participants?
Does the training include regular opportunities for feedback, reinforcement and practice?
As with other walks of life, in facilitation too, practice is the key to success. The most effective facilitators work hard to prepare for trainings and are always learning and improving their skills.
2.
3.
4.
5.
6.
7.
Workshop opening and introductions: welcome participants and enable them to get to know each other and the facilitators. Logistics: give information on boarding, lodging, venue facilities, travel arrangements and per diems, if any. Setting norms: set ground rules so everyone has a shared understanding of how to work together. Expectations: clarify participants expectations from the workshop. Objectives and schedule: outline the objectives, content and timings of the workshop. Although shared with participants at the start of the workshop, schedules are often flexible and changed to meet their needs and interests. Energizers: helps participants to relax and lifts their energy and enthusiasm. Presentations: give information on a particular topic or share experiences. Group work: discussion in small groups makes the program lively and provides a quick overview of participants views. Fieldwork: enable participants to learn by practicing new skills. Recaps: provide a summary (usually by participants at the start of each day) of what has been covered so far. Parking Lot: a sheet for participants to park i.e., stick or pin, issues that need to be covered but are not appropriate for that moment in the workshop. Mood barometer: a sheet with three moods (can be smiley faces with three different expressions, ranging from happy to normal to sad) where participants tick what they feel describes their attitude best at the end of each day. Action plan: for participants to clarify what concrete steps they will take after the workshop to use the new skills and knowledge they have gained. Workshop evaluation: enables participants to address the strengths and weaknesses of the workshop. Facilitators debrief: to discuss what worked and what did not work in the program and identify improvements for the future.
CEDPA. 1995. Training Trainers for Development. Washington DC: Centre for Development and Population Activities Pretty JN et al. 1995. A Trainers Guide for Participatory Learning and Action. London: International Institute for Environment and Development* PRIA. 1987. Training of Trainers: A Manual for Participatory Training Methodology in Development. New Delhi: Society for Participatory Research in Asia* Wood S, Sawyer R and Simpson-Hubert M. 1998. PHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrheal Disease. Geneva: World Health Organization
GUIDANCE NOTE 2
Key Messages
Inadequate sanitation adversely impacts human well-being. In India, reported coverage of rural sanitation has registered an impressive increase since the launch of the Total Sanitation Campaign of the Government of India. However, we have a long way to go, and usage and sustainability need to be addressed along with scaling-up.
What is Sanitation?
Sanitation refers to interventions for the safe management and disposal of excreta, with the principal safety mechanism being the separation of excreta from all future human contact. It includes both hardware (e.g., latrines, sewers) and software (e.g., handwashing, regulation).
Flies
Feces Fields Traditional pit toilet Ventilated improved pit or flush toilet Fluids
Food
Source: Participatory Hygiene and Sanitation Transformation Manual (PHAST) 1998, after Wagner and Lanoix 1958. Wood S, Sawyer R and Simpson-Hubert M. 1998. PHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrheal Disease. Geneva: World Health Organization.
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Sanitation and human dignity: surveys have found that people value household latrines, more for the resulting convenience, privacy, safety, prestige (e.g., families are ashamed when they cannot offer guests proper toilet facilities) and aesthetic benefits (sight, odor), than for their health benefits (Bruijne et al. 2007). The privacy afforded by adequate sanitation gives a sense of dignity to people, especially women. In addition, school latrines have been proven to be linked with continued education enrollment of teenage girls and young women, particularly at puberty (Government of Philippines et al. 2005). Sanitation and the environment: improperly disposed human waste is a major polluter of rivers and aquifers. This depletes waters of oxygen that is needed to sustain aquatic life. Investment in sanitation can dramatically improve the quality of water bodies. Sanitation-related burden of disease and economic impact: sanitation remains one of the biggest development challenges across developing countries. Consider these facts:
Four out of 10 people in the world, 2.6 billion, lack access to adequate sanitation. South Asia has one of the lowest sanitation coverage rates at 36 percent. Diarrheal diseases are the single biggest killer of children under five in poor countries (Water Aid 2006). Illness and death linked to poor sanitation contributes to malnutrition, loss of productivity and has repercussions on the educational enrollment of children, especially girls.
Bruijne G et al. 2007. Sanitation for All? Thematic Overview Paper 20. Netherlands: International Water and Sanitation Centre Planning Commission. 2002. Water Supply and Sanitation: India Assessment 2002 Water Aid. 2005. Drinking Water and Sanitation Status in India: Coverage, Financing and Emerging Concerns. New Delhi: Water Aid Water Aid. 2006. Dying for the Toilet. United Kingdom: Water Aid Wood S, Sawyer R and Simpson-Hubert M. 1998. PHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrheal Disease. Geneva: World Health Organization
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GUIDANCE NOTE 3
Key Messages
Despite significant investment in toilet construction, traditional sanitation programs have failed to motivate people to stop open defecation. By contrast, a community-driven total sanitation starts from the assumption that it is not just the availability of toilets, but motivating behavior change at the collective level to stop open defecation that is important for safe sanitation to take effect.
Negligible community participation. Limited attention to hygiene education or school sanitation. Promoted single standard design of latrines that was often of high cost relative to household incomes. Latrine construction took place largely through coercion, often as an obligatory condition for access to development projects e.g., water supply schemes. Offered relatively high hardware subsidies that could not be sustained by the Government or donor. Was not effective in reaching the poorest members of communities.
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From teaching and educating to facilitating communities own analysis. From we must provide toilets to communities can do it. From we persuade and do it to we motivate communities to take independent decisions and action. From top-down standard designs to bottom-up innovations (they design). From hardware support to supporting people and processes (adapted from Kar 2005).
How is Community-driven Total Sanitation different from a Traditional Approach Focused on Toilet Construction?
The table below illustrates some of the key differences: Elements Focus Traditional Approach Latrine construction. Community-driven Total Sanitation Stopping open defecation.
Technology
Menu of options.
Motivation
Individual subsidy.
Igniting behavior change through self-realization of harmful effects of open defecation. Subsidy as incentive routed through collectives. Focus on meeting ODF outcome at community level. Sustained behavior change and open defecation free villages. High; at lower cost.
Financial
Individual upfront hardware subsidy given. Focus on number of toilets constructed. Increase in number of latrines.
Monitoring
Outcome
Impact
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Shift from a high-subsidy to a low-subsidy regime. Flexible menu of technology options. Implementation in campaign mode. IEC campaign to create demand for improved sanitation services. Development of supply chain to meet the demand stimulated at the community level. Shift from hardware subsidy to performance incentives through the Nirmal Gram Puraskar.
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PRI
10.00
Individuals
0.10
0.20
0.30
0.20
0.35
0.50
Providing fiscal incentives to reward outcomes is a significant shift from the traditional approach to sanitation provision. The NGP scheme has elicited a tremendous response, with number of local governments awarded going up from a mere 40 in 2005 to nearly 5,000 in 2007. By providing incentives to community efforts to meet collective gains in sanitation, the scheme helps to raise the status of the winning village, create peer pressure among neighboring villages, and stiff competition among all tiers of governance within and across states. Top Five States Performance for NGP: 2005-07
4,959
1,974 769 40 AII India 13 381 576 1 4 Gujarat 0 40 488 11 134 475 296 13 119 Tamil Nadu
Maharashtra
Uttar Pradesh
West Bengal
Performance in 2005
Performance in 2006
Performance in 2007
Source: Govt. of India, Dept. of Drinking Water Supply <http://ddws.nic.in/TSC/crsp/TSCPhy_st.asp?Form=ALL> Accessed 6 May 2007.
DDWS. 2004. Guidelines on Central Rural Sanitation Program Total Sanitation Campaign. New Delhi: Department of Drinking Water Supply Kar, K. 2003. Subsidy or Self-Respect? Participatory Total Community Sanitation in Bangladesh Sanan D and Moulik SG. 2007. Community Led Total Sanitation: An Approach that Works. New Delhi: Water & Sanitation Program
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GUIDANCE NOTE 4
Key Messages
Community-driven total sanitation is a significant departure from the way that rural sanitation programs are usually implemented. The key principles can be summarized as follows: Focus on outcomes rather than building toilets. Focus on collective behavior change rather than mobilizing individual households. Accommodate a variety of technological options to get people on the sanitation ladder. Promote private suppliers/entrepreneurs to respond to demand. Appropriate institutional frameworks are key to achieving scale and sustainability. Focus on incentives that reward outcomes rather than provide upfront hardware subsidy.
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38 95% 26 100%
40 35 30 25 20
29% 7
15 10 5 0
Almost ODF
Source: Formative research by WSP Knowledge Links for IEC Manual in Himachal Pradesh, 2005.
Why Accommodate a Variety of Technological Options instead of Prescribing a Single Latrine Model?
In the past, rural sanitation programs provided limited technology options. Decisions were made by technical experts and handed down to community members, who typically contributed by providing labor for the construction of a predecided design. This top-down approach, with no community participation in decision-making, has proven unsustainable in India and elsewhere because toilets built in this way were either not used or used for alternative purposes, e.g., storage. The lesson learnt from this experience is that the choice of sanitation technology adopted has to come from the people using the latrine. In addition, it has been observed that improvements in sanitation systems generally occur incrementally rather than in a single leap (Cairncross and Feachem 1993). What is promoted in community-driven total sanitation is a switch from open defecation to a safe yet affordable sanitation option. While affordability is naturally determined by individual household circumstances, the availability of relatively low-cost options particularly helps those who are uncertain about changing their habits to get into the habit of using a toilet. The significance of the first relatively low-cost toilet is enormous in terms of breaking the habit of open defecation (Kar 2005). Experience with community-driven total sanitation shows that the users of relatively low-cost toilet models adopt upgrades or graduate to more expensive models, using their own resources, when the design life of their first toilet is over.
What Role do Private Sanitation Demand and Suppliers Play in Promoting a Total Sanitation Approach?
Obviously, if communities are upgrading their toilets, there will be a market for private suppliers to sell sanitary goods and provide the required services. Thus, community-driven total sanitation stimulates entrepreneurs to produce and market latrine hardware, such as different types and grades of pans, rings and slabs. Field experience shows that in response to demand for sanitation products and services, local innovations have resulted in a range of differently priced products, and a spontaneous and competitive market has developed. Private suppliers have also taken the initiative to undertake promotional activities for their business.
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NGO interventions have been successful in demonstrating the total sanitation approach but experience shows that local government involvement in partnership with civil society organizations accelerates scaling up.
13
381
2007
1,974
100
200
300
400
500
600
700
800
900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000
Source: Govt. of India, Dept. of Drinking Water Supply <http://ddws.nic.in/TSC/crsp/TSCPhy_st.asp?Form=ALL> Accessed 6 May 2007.
Subsidy is not effective in creating demand for safe sanitation as people defecate in the open not because they cant afford latrines but because safe sanitation is not a felt need. Subsidies raise community expectation of getting free money from outsiders and community initiative to change its own sanitation status takes a backseat. The Government of India has spent huge amount of money on subsidies in the past two decades but around 80 percent of people in rural India continue to defecate in the open (2001 Census). Stopping open defecation does not require large sums of money as there are a variety of affordable technological options available.
Instead of giving upfront subsidies for the construction of latrines, providing incentives for sanitary outcomes has been found to be effective in achieving communitywide total sanitation. Offering rewards (financial/nonfinancial) for communities that have completely ended the practice of open defecation empowers the collective to develop appropriate methods of addressing individual and collective sanitary behavior change. The Nirmal Gram Puraskar of the Government of India (see boxed item on Nirmal Gram Puraskar in Guidance Note 3) is an effective example to demonstrate this point. Incentive schemes introduced by State governments also motivate local governments and communities to achieve sanitation outcomes, e.g., the Sant Gadge Baba Gram Swacchata Abhiyan introduced by the Government of Maharashtra.
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Cairncross S. and Feachem R. 1993. Environmental Health Engineering in the Tropics: An Introductory Text. Chichester: John Wiley & Sons* Kar, K. 2003. Subsidy or Self-Respect? Participatory Total Community Sanitation in Bangladesh Sanan D and Moulik SG. 2007. Community Led Total Sanitation: An Approach that Works. New Delhi: Water & Sanitation Program WSP-Knowledge Links. 2005. Formative Research for IEC Manual. New Delhi: Water and Sanitation Program-South Asia
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GUIDANCE NOTE 5
Key Messages
Supply-driven approaches assume that if people are better informed, they will change their behavior. By contrast, community-driven total sanitation relies on the triggering approach which seeks to identify the triggers or factors that motivate people to change their behavior. Triggers can work on individuals or collectively, but the latter is more sustainable as it generates social pressure to prevent individuals from reverting to ingrained habits. Triggering can lead to four types of outcomes: matchbox in a gas station, flames under ash, spark, and damp matchbox. Each is briefly discussed below.
Types of Triggers
Triggers broadly fall into two categories: Individual and Community.
Individual Triggers
Some of the individual triggers related to sanitary behavior are:
Dignity and privacy. Shame (amongst women when watched by passers-by or among men how can you allow the women of your house to publicly defecate in the open when people may be watching?).
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Safety of children and elderly against falling down during rainy season or night-time. Fear (of darkness, wild animals, loss of money due to medical expenses, etc.). Prestige (when guests from urban areas visit, families feel embarrassed at being unable to provide adequate toilet facilities). Convenience (for the elderly, infirm, pregnant ladies and children, during bad weather or sickness).
Different individuals change behavior due to different reasons. However, behavior change triggered by such individual reasons is often sustained only until the reason remains in existence, e.g., a family that builds a household latrine because it is more convenient after dark, may continue to defecate in the open during daytime. Therefore, behavior change triggered in this manner is partial and the risk of fall-back is higher.
Community Triggers
Community triggers are factors or situations that concern and affect a community as a whole, thus prompting every member within it to change a behavior that is collectively perceived as hazardous. Some of the community triggers related to eliminating open defecation are:
When the community realizes that their health is at stake due to their own habit or the habit of others to defecate in the open, the community collectively resolves to change its behavior. Once the process is initiated, members begin to monitor each others behavior within the community. Thus, those who have a tendency to fall back are also prevented from doing so due to the social pressure created after such a collective resolution. Behavior change, when triggered by such collective concerns or situations, is more likely to be sustained.
Matchbox in a gas station (petrol pump mein maachis): refers to a situation where everyone agrees to stop open defecation and start the action immediately. Fire under ash or promising flames (raakh ke neeche aag): is the situation where most of the people have agreed. Scattered sparks or hope (chingaari): is the situation where the majority is undecided, but few individuals in the community agree to act promptly. Damp matchbox (bheegi diya salai): is the situation where community-driven total sanitation exercises are not able to trigger any positive response at all.
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GUIDANCE NOTE 6
Effective facilitation is key to community-driven total sanitation. Tools to facilitate participatory total sanitation can be implemented in any sequence, provided a rapport has been established with the community. This note provides an overview of different tools, explaining the purpose and process guidelines on how to use these in the field. Where appropriate, Dos and Donts are included for facilitators.
Rapport-building
Purpose
Set the stage for subsequent activities by developing mutual trust, agreement and cooperation.
Process Guidelines
Various techniques can be used to break the ice. You can begin with a simple self-introduction and begin a discussion with a few community members as you informally walk through a village. To broach a private and sensitive topic like sanitation/defecation, sometimes directly hitting the issue helps, while at other times, the topic is best approached at after talking about the general cleanliness situation in the village. Try to meet with as many people as possible and understand their perception of sanitation, defecating in the open, and how this affects their well-being. Try to encourage women to share their experiences as they suffer the most because of poor sanitation but often lack an opportunity to voice their views.
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Rapportbuilding
Action planning
Defecation mapping
Calculation of feces
Dos Think you are going to the community only to facilitate, not to teach. Ask people what the local words for feces and defecation are and use these throughout your interaction with them. Be alert and take interest try to remember names and potential change agents, e.g., Anganwadi workers, member of PRIs/SHGs.
Donts x Dont forget to introduce yourself and explain why youre there. x Dont prolong introductions longer than necessary, especially in a large group. x Dont be impatient and start firing questions from a checklist.
Process Guidelines
After initial rapport-building, the facilitator can ask the group to show her the cleanest and dirtiest places in their village. Substantial time must be spent at both these locations to discuss why the group feels these locations to be cleanest or dirtiest. This helps understand popular perceptions related to clean and unclean in the community, giving useful clues to the facilitator to build further.
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Another way to do the walk could be the classical method to first take a round of the entire village, including the open spaces, and help the group observe general cleanliness conditions. Try to make the process interactive by asking questions such as those suggested in the following checklist.
Where do men, women, elderly and children of the village defecate? Visit and observe the area. Where and how is an infants excreta disposed off? Where do people defecate at night? Where do people defecate during monsoons or winters? Where do we fetch our drinking water from? Where do people shower and wash their utensils? Is the area around our water sources clean? Are household toilets functional? Visit some houses with toilets during the walk. Are our lanes, agriculture fields and open areas of the village dirty or clean? Do we or our children defecate around water sources, forests, agriculture fields and in the backyard of the house during day or night?
Try to locate areas of open defecation and visit all the different types of latrines along the way (see observation checklist). When this is proposed, some people may be hesitant or even leave the group as they feel embarrassed to show outsiders the dirty spots of the village. However, since this is an important step, try to persuade these people to join in the transect. Spend substantial time discussing in open defecation areas. Dos Be curious. Walk slowly, observe carefully. Dont miss an opportunity to talk to passers-by. Give positive reinforcements for initiatives observed in the village during the transect. This could also be outside the purview of sanitary conditions of the village. Donts x Dont be bored or bore the group by lecturing or asking for too much information that you wont use. x Dont avoid the defecation areas. x The objective of the activity is to instill a feeling of disgust but not to insult anyone. At any point, do not pass judgment on the community.
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Defecation Mapping
Purpose
To facilitate analysis of big picture with respect to the situation of the village vis--vis sanitation this exercise will enable community members to visualize defecation areas and the close proximity of these areas to their homes.
Process Guidelines
1. 2. 3. 4. 5.
First draw a boundary of the village with chalk/piece of brick. In case neither of these are available, wheat flour or a piece of coal can also be used for the purpose. The boundary could somewhat look like this.
Ask community members to mark the main spots of their village like school, temple, panchayat bhawan, Anganwadi, all water points like handpump, taps, well/with blue color powder.
Next, each member should plot their house within the boundary with the stones. Large stones (L) shall denote big puckka houses of rich people while small stones (S) shall denote kutchha houses belonging to poor families. The medium-size stones (M) should be used for average families which are neither very rich nor very poor. Alternatively, chalk could also be used for the purpose.
Also, mark the agriculture fields and forest area by spreading leaves. After the houses have been marked, every member present should write the name of the head of the family or of self on a piece of paper and place it beneath the stone.
Now members who defecated in the open on the same morning would be asked to raise hands and then plot the location used for defecation with yellow colored powder. Once every member has marked his/her defecation site, arrows from the defecation sites to their houses would be drawn. Members would also be asked to locate the sites where children defecate (drains, etc.) or adults defecate during odd hours.
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Dos Choose an open space and draw a large map in which lots of people can participate. Encourage people to use local material for mapping stones, sticks, leaves, etc. Ask questions about the map, e.g., which is the dirtiest neighborhood? Second dirtiest? And so on. The map is not an end in itself but a means to facilitate community understanding of their sanitary conditions. Transfer the map to paper and try to have it displayed in a prominent place. The map can be used as a monitoring tool as the village progresses toward ODF status.
Donts x Dont draw the map yourself! The facilitators role is to facilitate the mapping. You can encourage initially by drawing a major landmark. After that, let community members take over and observe community dynamics who is taking the lead? Who is being passive? Which issues do people spend time discussing?
Calculation of Feces
Purpose
To quantify the magnitude of the sanitation problem.
Process Guidelines
While the defecation transect and mapping exercises make people aware of the existence of the problem, the calculation of feces makes them realize the scale of the problem. Taking an average of 250 gms (or local unit of measurement, e.g., tola/maund) of feces produced per person per day, the calculation first determines the amount for a day (250 gms X population of the village). A daily figure can be multiplied to figure out how much feces is produced each week, month or year, which may run into tons. The quantum of human feces deposited in their area generally horrifies the community, an emotion which should be tapped. The analysis of where this feces goes has been described through a flow diagram.
Process Guidelines
The calculation of feces should lead to further questions: where does all the fecal matter go? Using a flow diagram, the movement of the feces after defecating is traced (this can be done on a chart paper, blackboard, etc.). The flow of feces will include its lifting in the dry state by wind, getting into the feet of chickens, pets, flies, mixing with water streams (especially during rains), etc. The idea that has to be gotten across is that the very feces that we have thoughtfully deposited away from us and our homes, doesnt go away. Instead, it makes its way back through these carriers. The revelation that they have been ingesting feces in some form or other brings revulsion. Try to sustain the tempo here by asking related questions: how would the ingested feces affect our health?
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At this stage, the facilitator can ask community members to calculate spending on health expenses incurred due to ingesting feces. First, ask members to list out the diseases that can be caused by ingesting feces. Next, try to calculate the medical bill of treating a disease, say diarrhea, by estimating cost of travel to a clinic, doctors fees, cost of medicines, cost of productive time lost, and so on. This figure (medical expenses to treat diarrhea for one week) can be multiplied by estimated number of cases in a family in one year, and from there on multiplied by the number of families to calculate how much the village spends on medical expenses to treat one sanitation-related disease in a year.
One Person
Around 7 kgs
Around 90 kgs
30 Days
1 Year
Around 45,000kgs
1 Day
30 Days
1 Year
Dos Do ask questions of men, women, elderly, children and try to get community members to take responsibility and work out things for themselves. If the group hesitates to choose between nurse/doctor and traditional healer, you can help by reminding them its the type of health problem and expense of treatment that is important, not the type of healer. This activity may have shown you that the group lacks health knowledge. If this is so, the facilitators role is to help the group find out for itself how disease spreads the way disease spreads, how people handle water and how it is linked to open defecation.
Donts x Dont lecture or try to educate the community about the diseases caused by open defecation, flies as disease carriers or need for handwashing. x Dont worry if the group misses out what you think are important diseases. This is a discovery in itself. It means that you will have to help the group to discover this information themselves. Do not suggest diseases instead let the group make suggestions based on its knowledge and experience.
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Process Guidelines
Testing with H2S vials is very simple and it reveals the extent of contamination of the water that people have been using for bathing, drinking, cooking, etc. This step is particularly useful in places where people defecate in the water (rivers, lakes, backwaters, etc.) and there may be less visual impact of doing a defecation transect/walk of shame. Count the number of drinking water sources in the village including handpumps, wells, streams and taps, and arrange to get as many numbers of samples. Take samples from surface water sources directly into the bottle. In case of groundwater sources, first fill water into a clean glass, and then transfer to the bottle for testing. Check the samples after 24 hours. If the water turns black, that is a proxy for fecal contamination. If the water color is unchanged, wait for another 24 hours to confirm the test results. If the color does not change to black, it means the water is safe to drink. Share the results of the test and tell families that are using contaminated water sources to use other sources or treat water before use. Bury the vial safely in around 2 ft. deep pit after throwing away the contaminated water in the pit, and breaking the vial inside the pit and covering it with soil. Dos Keep the H2S vial and bottle safely at recommended temperature and away from sunrays and children. Donts x Dont pass judgment on the community. Try to use the test results to help them analyze their sanitary conditions and impact on their health.
Decision-making
Purpose
Ignition to switch from facilitating analysis of the sanitation conditions to assessing whether the community is ready to take action.
Process Guidelines
At the end of the analysis, many in the group may actively want to change the situation. To tap into this motivation, the facilitator could ask: who will go for open defecation tomorrow? Or who will take a bath in the river in which everyone has been defecating? Ask them to raise their hands. If no one raises their hands, ask what can be done instead. Usually, at this stage arguments run high between community members on how to stop open defecation. Dont interrupt or advise. If questions are addressed to you, you may tell them that as an outsider you dont know about the local situation and they would know best what to do. Tell them they are free to choose they can even continue their age-old practice of open defecation! If at this stage some people say that they are interested and are willing to construct toilets but it is costly and they would not be able to afford it, tell them it is not. Quickly draw a picture of simple pit latrine. Ask how much that would cost and how difficult it would be to construct a similar direct pit latrine? Let them know that this was not your design, but one developed by poor people in one of the poorest countries of the world (additional information on sanitation technologies is included in Guidance Note 6). You could also share experiences of other communities who have taken up total sanitation move and have achieved success.
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Dos Firmly say that you are not there to sell toilets or distribute subsidy. This perception about the high cost of toilets is derived from supply-driven projects of the past, which prioritized high-cost solutions.
Donts x Dont prescribe any sanitation model or technology. Remember, the central idea of community-driven total sanitation is to let the community decide, not prescribe. x Dont worry if no one talks about starting any local action immediately. Politely thank them and tell them that you will record them as a village where people are willing to continue open defecation and eating one anothers feces.
Action Planning
Purpose
To discuss three major next steps: (1) how to establish a Sanitation Action Committee; (2) create an action plan and decide deadlines; and (3) decide actions for the next day.
Process Guidelines
As a first step, it is necessary to have a steering and management committee which will oversee the completion of this process. This committee, to be set up at this meeting, can include PRI members and if it exists, members of an active Village Water and Sanitation Committee. Next, decide on an action plan and approximate time frame to achieve the end of open defecation in the village. Discussions can be held on material availability, how to procure these, etc. The committee may also decide on whether any fines need to be imposed on those undertaking open defecation after a period of time. Although the process of completely ending open defecation will take some time, it is necessary to start the first step toward that process immediately. Some actions that can be taken immediately are: Digging pits to use as makeshift latrines. Learning more about low-cost technology models. Process of Community Realization and Action toward an ODF Environment
Identification of right person in the community Registration Signboard
Triggering tools
Ignition
Spreading messages
Ten households
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Putting together a list of masons and sanitaryware suppliers, or entrepreneurs willing to take up the challenge. Making a list/map of all households in the village and their sanitation status. Identifying suppliers of sanitary materials. Getting commitments from well-off families to start constructing latrines immediately (adapted from Kar 2005). Donts x Dont prescribe models of latrines. Encourage people to innovate and use local materials while following broad technical quality parameters.
Dos Encourage better off families to help the less well-off find ways to end open defecation as this will benefit them also. E.g., they may lend materials or allow poorer families to use their toilets in the short term. Encourage local governments to facilitate the discussion on how to support less well-off families. Look out for natural leaders who emerge from the PRA process and encourage them to take the lead in finding ways to end open defecation. Involve children in the discussion and ask them what they will do to end open defecation. Children often take an active interest and form their own monitoring groups and slogans.
Kar, K. 2005. Practical Guide to Triggering CLTS Kar, K. 2003. Subsidy or Self-respect? Participatory Community Sanitation in Bangladesh Sanan D and Moulik SG. 2007. Community Led Total Sanitation: An Approach that Works. New Delhi: Water & Sanitation Program
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GUIDANCE NOTE 7
Sanitation Technologies
Key Messages
This note provides basic information about three aspects of sanitation technologies: Components of a toilet. Sanitation technology options and their relative merits. Factors that influence decision-making on sanitation technology options. Ways to adapt sanitation technologies to difficult conditions.
Disclaimer
The total sanitation approach strongly discourages sharing any kind of information on sanitation technologies with the community without an expressed demand from their side. Even if there is a demand from the community for information on sanitation technologies, a facilitator should not prescribe models. Instead, a facilitator should try to share general principles of design or technical parameters, e.g., distance of latrine from water source or depth of pit.
A substructure to isolate and contain excreta. A platform with a squatting pan or hole. A superstructure for privacy and protection from climatic factors.
This basic form can be modified by adding features or components that facilitate hygiene, operation, maintenance, esthetics or safety, e.g., a screened vent pipe can be installed for controlling smell and flies, a water seal can be provided for odor control and improved esthetics, an additional pit can be dug to increase the working life, and so on. Naturally, as features are added, the cost of a latrine goes up. What is important is to see how effectively a sanitation facility helps individuals and the community to break the habit of open defecation. The remainder of this section is devoted to a brief description of the basic components of a latrine.
Latrine Substructure
A substructure should isolate and store excreta in a way that prevents harmful pathogens being carried to a new host. A substructure can be a pit or a tank and these are described briefly below:
In a dry pit, excreta comes in direct contact with the soil. This option has many drawbacks such as odor and insect nuisance and is generally not recommended for individual household application. However, if constructed on the outskirts of a place that is usually used for open defecation, this can be an entry level option for developing the habit of using a toilet. In a leach pit, liquid and gas components of the excreta get absorbed by the soil through holes in the pit, while solids are decomposed into manure. It is preferable to line leach pits to prevent the walls from collapsing. Lining can be done with a honey-combed brick wall, perforated concrete rings, twigs, split bamboo matting, modified drum, stone masonry, etc.
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A septic tank comprises a watertight settling tank with one or more chambers through which waste is deposited into the tank. This system does not decompose the wastes. The pathogen-rich sludge deposited inside the tank needs to be pumped out once the tank fills up.
Despite the differences between a leach pit and septic tank, it is important to note that a leach pit has lower initial cost and requires practically nil daily maintenance. The decomposed excreta becomes harmless biofertilizer and needs to be removed once in three to five years and not daily, making this advantageous from an environmental point of view. By contrast, wastes are not decomposed in a septic tank and need to be pumped out mechanically once the tank is full. The sludge deposited in the tank needs to be safely disposed.
Superstructure
Superstructure is a room for housing the latrine. Its design is irrelevant to the operation of the latrine but crucial to the acceptability of the latrine to the user, as it provides privacy and protection from climatic factors. Superstructures range from a simple shelter of sacks or sticks to a building of bricks or blocks which can cost more than the rest of the latrine! The choice of superstructure will reflect the income, customs and preferences of the user.
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Plastic sheets
Thatch
Corrugated tin
Jute sacks
Cement
Dry bushes
Sanitation Options
Improvements in sanitation systems generally occur incrementally rather than in a single leap (Cairncross and Feachem 1993). Experience with community-driven total sanitation shows that users of relatively low-cost toilet models upgrade to more expensive models when the design life of their first toilet is over. This section provides a description, and advantages and disadvantages of different technology options, from simple to complex (see figure of sanitation ladder). These options bring out variations in the three components of a latrine discussed above (substructure, platform with pan/hole and superstructure) as well as their applicability to different physical conditions.
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Disadvantages
Low cost and easy to understand and construct. Benefit to farmers as fertilizer.
Short life as shallow pit is soon filled. Odor. Considerable fly nuisance. Spread of hookworm larvae.
Disadvantages
Does not need water for operation appropriate for areas with water scarcity or snowfall. Simple to construct: can be built by a person with minimal external assistance. Helps get people on the sanitation ladder; amenable to incremental improvements. If properly built, provides an effective barrier to disease that is at least as good as other sophisticated methods. Small land requirement on plot.
Odor. Fly and cockroach nuisance (and mosquito nuisance if pit is wet) unless there is a tight fitting cover over the squat hole. Excreta may be visible. Risk of falling into the pit. Need to shift superstructure each time a new pit is dug, increasing overall costs.
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Air flow
Disadvantages
Same as simple pit latrine. In addition: control of flies and odor. Amenable to incremental improvement.
Does not control mosquitoes. Need to keep interior dark (deters flies).
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Disadvantages
Control of flies and mosquitoes. Absence of smell. Contents of pit not visible. Offset type gives users the convenience of a WC. Latrine can be in-house.
Affordability. Social customs and traditions. Personal hygiene practices (e.g., material used for anal cleansing). Preparedness for emptying. Preparedness for maintenance.
Technical factors relate to physical parameters. They determine the feasibility of planning and design, and ultimately the effectiveness of the chosen option. Examples of technical factors include:
Availability of water. Availability of space. Level of groundwater table. Soil permeability. Risk of flooding.
The latrine squatting slab and superstructure can be on the roof of the house but the pit can be under the main room of the house. In many villages, latrines have been constructed on land donated by the Gram Panchayat or wealthy members of the community. Two neighbors can have separate superstructure and squatting slabs but share a common pit. Households which do not have adequate space in the house for building toilets can come together to construct community or group latrine facilities.
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Shared toilet
Internal toilet
Using a toilet takes as much water as people use for anal cleansing when they defecate in the open. Water use can be reduced by using other materials for anal cleansing, e.g., leaves, stones, paper. The slope of the pan can be so designed that it uses minimal water. Before defecating, pour a little water in the pan. This, along with the slope of the pan, will ensure that feces does not stick and also maintain cleanliness.
What type of latrine can be built where there is hard rock close to the surface?
It can be difficult and costly to dig a pit where hard rock is close to the surface. Some strategies to deal with this are:
A raised pit latrine can be built where the pit is partially above the ground level. Using the same concept as a raised pit latrine, mounds or platforms can be built whereby people defecate into drums or buckets and arrangements are made for safe disposal of the contents.
What type of latrine can be built where there is a high water table?
If water table is high and groundwater is used for water supply, a number of solutions can be applied to prevent contamination of groundwater, such as:
Raised pit latrine: the bottom of the pit should be at least 4.92 ft. above the water table level. It is important to know how many people will be using the pit so that is can be sized accordingly. A large number of small capacity latrines, wide rather than deep, are preferable to fewer large capacity latrines. Sand-enveloped pit latrine/raised pit latrine: a sand envelope can be constructed around a lined pit to reduce risk of groundwater pollution. This envelope is usually 1.64 ft. thick.
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2 ft.
Toilet pit design modified to suit rocky terrain: part of the toilet pit is built above ground level to make the shallow 2-3 ft. pit a total of 4-5 ft. 'deep'.
Franceys R et al. 1992. Guide to the Development of On-site Sanitation. Geneva: World Health Organization WSP-Knowledge Links Pvt. Ltd. 2005. A Discussion of Technologies for Sanitation in Rural Himachal Pradesh. New Delhi: Water and Sanitation Program-South Asia WSP. Manual on Technology Options for Rural Sanitation in Maharashtra. New Delhi: Water and Sanitation Program-South Asia
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GUIDANCE NOTE 8
Key Messages
Hygiene education is a potentially vast topic. To narrow the focus, this note details three hygiene practices: Washing hands with soap/ash after defecation and before eating. Washing hands with soap/ash after disposing an infants feces. Proper and safe handling of drinking water.
Washing hands with soap/ash after defecation and before meals: While mud creates friction on the hands and will assist in cleansing, ash and soap will kill/remove bacteria. Washing hands with soap and ash after disposing an infants feces: The popular perception that the feces of infants are harmless needs to be dispelled and greater precautions need to be exercised after handling babies. Proper and safe handling of drinking water: Since a high proportion of the contamination of water occurs between the water collection point and consumption, the safe storage and handling of water is an important hygiene practice.
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What is the proper way of washing hands? Hands are believed to be washed properly only when there are no bacteria, pathogens or any other dirt left on our fingers or in our nails after washing. For this, we need to wash our hands only with SOAP and WATER or with fresh ASH and WATER.
1 2 3 4 5
10
11
Critical Times for Handwashing We must NOT forget to wash our hands at following times:
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Feces are not exposed to other people or domestic animals. Feces are not exposed to flies. Feces are not moved or used as manure on the field before they have become harmless. Feces should not drain through the soil into water supply sources.
Home Filters Many of us have seen the filters used in households removing the harmful particles from drinking water. We can easily get this filter from the open market. While purchasing, we must make sure that it has an ISI mark on it. There is a candle in the filter that removes bacteria found in drinking water. These filter candles have to be cleaned by scrubbing with a hand brush under running water and have to be boiled to remove the impurities/bacteria. At regular intervals, say six months, the filter candle needs to be replaced. The filter has to be filled with water. Water can be used for drinking after one to two hours. Use of Chlorine Tablets Store water in a clean container. Drop chlorine tablets in the container. We can easily get these tablets from the Irrigation and Public Health (IPH) worker visiting our village or from the market. But we must ensure that we do not put more than 10 mg of chlorine tablets in a container of 20 liter capacity. Use this water for drinking after two hours. Bacteria and germs present in the water shall be killed by this time.
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Clean the water container thoroughly before filling water in it. Always cover the container after filling the water. Do not allow own/childs hands to touch the water in the container. Inside the kitchen/home, keep the water container on a raised platform, away from the reach of children or animals. Use a ladle for taking out water from the container. Wash hands before using the ladle or pouring the water.
WSP-Knowledge Links Pvt. Ltd. 2005. A Discussion of Technologies for Sanitation in Rural Himachal Pradesh. New Delhi: Water and Sanitation Program-South Asia
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GUIDANCE NOTE 9
Participatory Monitoring
Key Messages
Participatory monitoring helps overcome some of the limitations of conventional monitoring as it recognizes the key role that local people play in planning and managing their environment. The four main principles of participatory monitoring are: participation, negotiation, learning and flexibility. There are nine basic steps that can be followed to facilitate participatory monitoring in the context of community-driven total sanitation. These are described in this note.
Participatory Monitoring
External expert.
Communities, often helped by a facilitator. Community members and associated stakeholders at different levels. Design the self-assessment from data collection to analysis and learning from change. Wider qualitative and quantitative impacts, both expected and unexpected. Empowering; consultative (interviewing) and collaborative (PRA tools). Adaptive, flexible.
Who Participates
External consultants.
Provide information.
What is Measured
Method
Approach
Predetermined.
Source: Adapted from IDS (1998) and Pasteur and Blauert (2000).
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Participation: which means including those directly affected in collection, analysis and use of information. Negotiation: this involves reaching a consensus on what to monitor, how often, which methods to use, what the data means, how findings will be shared and action taken. Learning: participation and negotiation in monitoring leads to learning from change which forms the basis for further action. Flexibility: since the numbers, roles and skills of both those affected by change and the environment in which change is situated changes over time, flexibility is necessary (IDS 1998).
Define priorities
Identify indicators
Identify possible participants: who should be involved and who wants to be involved? For the process to be participatory, different stakeholders need to be included and not just the most vocal or accessible community members. Clarify objectives and expectations: this step helps to clarify why we are undertaking monitoring. Some of the reasons include: To know if we are making progress toward our goal, e.g., ending open defecation. To learn from experience are some pockets/areas performing better/worse than others? If yes, why is there a difference in performance? Can good practices/ideas be replicated? What are the key challenges and how have these been tackled? Define priorities: sanitation is a private behavior with public consequences. Therefore, the scope of issues that directly or indirectly impacts is potentially vast. However, for monitoring to be effective, it is essential to narrow down the scope to selected priorities. This must be agreed upon by the community members, taking the local context as well as resources available for monitoring into consideration.
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Identify indicators: this is often the most difficult step as each objective can be measured by different indicators. A thumb rule for selecting indicators that will provide information needed is that they should be SMART i.e., Specific, Measurable, Attainable, Relevant and Timely. In the past, the most common metric used by sanitation programs was the number of latrines built. However, field experience has shown that construction of toilets must not be confused with usage of sanitation facilities. Therefore, under community-driven total sanitation, the focus is on facilitating behavior change at the community level toward ending open defecation. Under this approach, constructing toilets is a means to an end, but not an end in itself. Accordingly, the focus of monitoring should be on the outcome (ending open defecation) and not on inputs (toilet construction). Agree on methods and responsibilities: there is a vast variety of methods and tools that can be used for monitoring (Pasteur & Blauert 2000). In fact, many trigger tools can be adapted for this purpose, e.g., transect/walk, defecation mapping and flow diagrams. Some methods and their applications are discussed below.
Mapping: to show the location and types of changes taking place in the area being monitored. An innovative way to monitor is to combine a social map/list of households with tricolored bindis or pins to flag the sanitation status of each household or group in an area. This map should be kept in a public place so that it is visible to all and it should be regularly updated. Venn diagrams: to show changes in relationships between groups, institutions, and individuals. Flow diagrams: to show direct and indirect impacts of changes, and to relate them to causes. Diaries: to describe changes in the lives of individuals or groups. Photographs: to depict changes through a sequence of images. Matrix scoring: to compare peoples preferences for a set of options or outcomes. Network diagrams: to show changes in the type and degree of contact between people and services.
Green
Yellow
Red
In addition to the methods used for monitoring, it is important to decide responsibilities for monitoring. One way to do this is to ask community members to volunteer for membership of sanitation monitoring committees. Separate committees can be set up for different parts of the village, based on recognized administrative divisions or number of households, e.g., each committee of five members is responsible for monitoring the sanitation status of a cluster of 30-35 households. Members of these committees can be youths, mothers, children or residents of a particular section of the village. The committees can meet on a monthly basis or nominate a member to represent the progress in their area to the Sarpanch or community leader responsible for the communitys sanitation status. It is important to note that participatory monitoring does not exclude the role of government or civil society organizations. Rather, successful initiatives demonstrate partnerships between communities and both government and nongovernmental organizations.
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Source: Adapted from: Pretty JN, et al. 1995. Participatory Hygiene and Sanitation Transformation Manual (PHAST) 1998.
Decide the timing and frequency of monitoring: certain indicators are best measured at key moments or are heavily influenced by seasonality, e.g., incidence of open defecation may increase/decrease depending on time of day or season. To avoid confusion, those responsible for monitoring must agree on the timing and frequency of monitoring, possibly in the form of a daily/weekly/monthly calendar. Collection and analysis of data: after the data is collected, it needs to be analyzed and shared with relevant people and groups. Consideration should be given to building the capacity of selected resource persons from the community such that they are confident of undertaking the analysis as per the standards required. Based on the analysis, the community should be able to understand and take decisions about: What progress has been made? What is working well? What is not working well? What more needs to be done? Using the information: the same data and analysis may need to be presented in different ways to convey key messages to different groups. It should be used by each relevant group in the decision-making process to solve problems and/or plan for the future. Sustaining participatory monitoring: to be sustainable, participatory monitoring must overcome certain common mistakes. These include: Assuming that everyone will have equal enthusiasm to participate. Imposing inappropriate indicators without adequate consultation or collecting unnecessary information. Being unclear about how the information will be used and by whom. Launching into the process with inadequate preparation (adapted from IDS 1998).
Abbot, J. and Guijt, I. 1998. Changing Views on Change: Participatory Approaches to Monitoring the Environment. SARL Discussion Paper 2, London: IIED Estrella M and Gaventa J. 1998. Who Counts Reality? Participatory Monitoring and Evaluation. IDS Working Paper 70. Brighton: Institute of Development Studies IDS. 1998. Participatory Monitoring & Evaluation: Learning from Change. IDS Policy Briefing: Issue 12. Brighton: Institute of Development Studies
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The findings, interpretations, and conclusions expressed are entirely those of the authors and should not be attributed in any manner to The World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the companies they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown in this work do not imply any judgement on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.